Treatment of Erectile Dysfunction - Impotence in Diabetes : Dr. Zaidi

Treatment of Erectile Dysfunction – Impotence is complex. Erectile Dysfunction is common among diabetics. However, Impotence can be due to a variety of reasons other than diabetes and, therefore, should be thoroughly evaluated by an expert in this field, preferably an endocrinologist.

Causes of Erectile Dysfunction – Impotence

Autonomic neuropathy due to uncontrolled diabetes

Poor circulation due to diabetes and Insulin Resistance Syndrome

Smoking

Excessive alcohol consumption

Certain drugs such as beta-blockers, thiazide diuretics, spironolactone, clonidine, antidepressants, anti-anxiety drugs, cimetidine, ranitidine, metoclopramide, and soy products

Low testosterone level

High prolactin level, a hormone produced by the pituitary gland

Prostate surgery

Psychological problems

In most diabetic patients, Impotence is a complex problem. There are multiple factors working in concert that lead to impotence.

Usually, diabetes is uncontrolled.

Patient is not on insulin-sensitizing drugs, which are Actos and metformin.

Also, the patient is on beta-blockers to control hypertension.

HDL cholesterol is low and triglycerides are high.

Circulation is poor.

The patient feels quite tired all the time due to a variety of reasons including uncontrolled diabetes, obesity, side effects of medicines, lack of Vitamin D and other vitamins and minerals, and the stress of daily life. You are not interested in sex when you’re tired, fatigued and stressed out.

Often these patients are depressed. Having sex is the last thing on their mind.

Treatment Of Erectile Dysfunction – Impotence

Treatment of Impotence is quite challenging. My approach to the treatment of Impotence in diabetic patients is as follows:

First, I thoroughly evaluate a patient for all of the causes mentioned above

Treat all the factors that I can identify in an individual patient

Manage their diabetes as well as other components of Insulin Resistance Syndrome, such as hypertension and cholesterol disorder, aggressively with my 5-step treatment approach

Stop any medicines that may contribute to impotence, such as beta-blockers, spironolactone, metoclopramide, or soy products

Make sure prolactin is not elevated and testosterone levels are normal for the patient’s age

I strongly encourage smokers to quit smoking

Those who are overweight are encouraged to lose weight, which also helps increase energy

With proper amounts of Vitamin D, calcium, potassium, magnesium, and other mineral supplements, they start feeling better
I also address their depression with my stress management strategy

After correcting all of these factors, I sometimes prescribe drugs such as Viagra, Cialis, or Levitra

Viagra (sildenafil)

Viagra must be taken about an hour before sexual activity. Headache, flushing and dizziness are frequent complaints that I have heard from my patients using Viagra. Please note that Viagra use has caused several deaths. Therefore, you should be very careful about using this drug. Patients on nitrates and alpha blockers such as Cardura (doxazosin), Hytrin (terazosin) must not use Viagra. Patients with heart disease should check with their cardiologist before using Viagra.

Cialis (tadalafil), Levitra (vardenafil)

After Viagra, two other drugs called Cialis and Levitra were released in the U.S. for treatment of Impotence. These are in the same class of drugs as Viagra. Their onset of action is faster than Viagra.

Cialis is effective during a twenty-four-hour period after its intake. Therefore, you have more flexibility about the timing of your sexual activity. Side effects of both Cialis and Levitra are similar to side effects of Viagra.

Other Options to Treat Erectile Dysfunction – Impotence

Other older treatment options for Impotence include a vacuum pump, injection of Caverject into the penis, MUSE, and lastly, a penile implant.

Vacuum pump

A vacuum pump works for some patients. Patients taking blood thinners should avoid it. A vacuum pump may cause bruising of the penis.

Caverject

With Caverject a special chemical known as prostaglandin E1 is delivered by injection into the penis. You need to learn the injection technique from a nurse at a urologist’s office. Penile pain and excessive stimulation of the penis are the main problems with these injections. However, it works in most people with Impotence.

MUSE

With MUSE (Medicated Urethral System for Erection), prostaglandin E1 is delivered through the opening at the tip of the penis. Penile pain, excessive stimulation of the penis, and dizziness are the main problems with this technique. It works in about 50% of patients with impotence.